20050400.pdfVP
FDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
IV/ WA/ I C, I �� it//
MAILING ADDRESS
1?311. 9-4 T H A AE
CITY zip TELEPHONE
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CITY ZIP TELEPHONE
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NAME I CBL#
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PERMIT EXPIRES V:111)':12)
PERMIT
NUMBER �2 06 6 V60
JOB SUITEIAPT#
ADDRESS
MEiSUBDIVISION NO. LOT NO. LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAPProved
RW Parmil Re""Od
Stlee-1 Use Parld Required
EXISTING PROPOSED inspection Requifed
Sirlewatk Required 13
REQUIRED DEDICATION FT Undefgtound 13
Wiring roquired 13
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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CITY ZIP ELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
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REPAIR
GRADING
CYDS
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( x FT.)
REMARKS
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
ITYPE OF USE BUSINESS OR ACITIVITY) EX AIN:
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TYPE OF r.r)tOSTRUCTION
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SPECIAL INSPECTION
REQUIRED 13YES
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CODE
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CONSULTANT
OCCUPAN
GROUP
OCCUPANT
LOAD
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NUMBER
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NUMBER OF
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GEOTECH REPORT
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STRUCTURUES G
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
city Surcharge
PLAN CHECK NO:
06;4, 05
Plumbing
9
Base Fee
4il:2
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
,U PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
CL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
77
in
V) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
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Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN CE
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Total Amt. D ue
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
112L �Q,
APPLICATION APPROV L
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
This application is not a pormil until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Building official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION.
receipt is acknowledged in space provided
Q F IA lIGNATUR DATE
WORKMEN'S COM PEN SATIWV RANCE AND RCW 18:27.
(425)
�SIGN URE (OWNER OR ENT)'
DATE SIGNED
7 -0220 b AT F/
71 MTBY
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL __V
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ��R`fllkr-FllfE ELLOW - INSPECTC
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC1110. 'ii,%NK -OWNER - GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE-3Z4/
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PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
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SITE ADDRESS 461 (R,�
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PERMIT.#2t0a'6- ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED 6!�l qj
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A field inspection was conducted. to determine compliance with approved plans. Final appi.oval
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denotes that there , are no objections. from the above signed ..Department to the release of.
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL.
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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El. Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL.
-Date- Signature
1:teinp:b1dg:fomis:.ocaprv1 3/25/04